NR 509 Advanced Physical Assessment 2026–2027 |
Chamberlain University Graduate Nursing Study
Guide, Midterm & Final Exam Prep, Advanced
Health Assessment, Physical Examination, Clinical
Reasoning, Differential Diagnosis, SOAP Notes,
Health History, System-Based Assessment &
Practice Questions
Question 1: A 45-year-old patient presents with a 3-week history of persistent,
dry, nonproductive cough. Which of the following findings in the history of
present illness is most suggestive of an ACE inhibitor-induced cough?
A. The cough is accompanied by fever and night sweats.
B. The cough resolves when the patient lies down.
C. The patient began lisinopril therapy approximately 4 weeks ago.
D. The cough produces clear sputum in the morning.
CORRECT ANSWER: C. The patient began lisinopril therapy approximately 4
weeks ago.
Rationale: ACE inhibitor-induced cough typically develops within 1 to 2 weeks of
initiation but can be delayed up to several months. It is a dry, persistent cough that
resolves after discontinuation of the medication. Fever and night sweats suggest
infection, positional cough suggests GERD or postnasal drip, and sputum production
suggests infectious or inflammatory etiology.
Question 2: During auscultation of the lungs, a nurse practitioner hears a high-
pitched, musical sound predominantly on expiration that is diffuse throughout
both lung fields. This finding is most consistent with:
A. Pleural friction rub
B. Wheezing
C. Crackles
D. Stridor
CORRECT ANSWER: B. Wheezing
Rationale: Wheezing is a high-pitched, musical, continuous sound heard predominantly
during expiration. It results from narrowed airways due to bronchospasm, edema, or
secretions and is commonly associated with asthma or COPD. Pleural friction rub is a
grating sound heard on both inspiration and expiration, crackles are discontinuous
popping sounds, and stridor is a high-pitched inspiratory sound indicating upper airway
obstruction.
Question 3: Which of the following chest pain characteristics is most
consistent with pleuritic chest pain?
A. Pain that is relieved by leaning forward
B. Pain that worsens with deep inspiration
,C. Pain that radiates to the jaw and left arm
D. Pain that is burning and occurs after meals
CORRECT ANSWER: B. Pain that worsens with deep inspiration
Rationale: Pleuritic chest pain is sharp, well-localized, and worsens with deep
inspiration, coughing, or movement. It is caused by inflammation of the parietal pleura.
Pain relieved by leaning forward suggests pericarditis, pain radiating to jaw/arm
suggests cardiac ischemia, and burning postprandial pain suggests GERD.
Question 4: A patient with a history of heart failure presents with bilateral
crackles at the lung bases, jugular venous distension, and 3+ pitting edema of
the lower extremities. These findings are most consistent with:
A. Pulmonary embolism
B. Pneumonia
C. Acute decompensated heart failure
D. Chronic obstructive pulmonary disease
CORRECT ANSWER: C. Acute decompensated heart failure
Rationale: Bilateral basilar crackles, jugular venous distension, and peripheral edema are
classic signs of volume overload in heart failure. Pulmonary embolism typically presents
with unilateral findings and acute onset, pneumonia presents with focal crackles and
fever, and COPD presents with wheezing and barrel chest.
Question 5: When performing a cardiovascular assessment, the nurse
practitioner palpates a thrill at the left sternal border. This finding is most
consistent with:
A. Normal aortic valve closure
B. Turbulent blood flow from a valvular abnormality
C. Pericardial inflammation
D. Normal venous pulsation
CORRECT ANSWER: B. Turbulent blood flow from a valvular abnormality
Rationale: A thrill is a palpable vibration caused by turbulent blood flow, often
associated with valvular stenosis or regurgitation, or a ventricular septal defect. It is
never normal. Normal valve closure is felt as a tap, not a thrill. Pericardial inflammation
produces a friction rub on auscultation, not a thrill.
Question 6: A 55-year-old male presents with sudden onset of tearing chest
pain radiating to the back. He has a history of hypertension and is diaphoretic.
Which of the following findings on physical examination would most support a
diagnosis of aortic dissection?
A. Blood pressure differential of 20 mm Hg between arms
B. Holosystolic murmur at the apex
,C. Bilateral crackles at the lung bases
D. Pulsus paradoxus
CORRECT ANSWER: A. Blood pressure differential of 20 mm Hg between arms
Rationale: A blood pressure differential between arms of greater than 20 mm Hg is a
highly specific finding for aortic dissection, resulting from obstruction of a major branch
vessel. Holosystolic murmur suggests mitral regurgitation, crackles suggest heart failure,
and pulsus paradoxus suggests cardiac tamponade.
Question 7: The nurse practitioner is assessing a patient for orthostatic
hypotension. The correct technique involves:
A. Measuring blood pressure only in the supine position
B. Measuring blood pressure while the patient is seated only
C. Measuring blood pressure supine, then immediately upon standing, and after 3
minutes of standing
D. Measuring blood pressure in the supine position, then after 10 minutes of standing
CORRECT ANSWER: C. Measuring blood pressure supine, then immediately
upon standing, and after 3 minutes of standing
Rationale: Orthostatic hypotension is defined as a drop in systolic blood pressure of at
least 20 mm Hg or diastolic of at least 10 mm Hg within 3 minutes of standing. Proper
technique requires measurements in the supine position, immediately upon standing,
and after 3 minutes of standing to capture the full hemodynamic response.
Question 8: Which of the following is the most common cause of left
ventricular hypertrophy detected on physical examination?
A. Mitral valve prolapse
B. Chronic hypertension
C. Pericardial effusion
D. Aortic regurgitation
CORRECT ANSWER: B. Chronic hypertension
Rationale: Chronic hypertension is the most common cause of left ventricular
hypertrophy due to increased afterload against which the left ventricle must pump. This
leads to concentric hypertrophy. Mitral valve prolapse, pericardial effusion, and aortic
regurgitation do not typically cause LVH as their primary manifestation.
Question 9: A patient presents with a new onset of atrial fibrillation. Which of
the following findings on cardiac auscultation is most consistent with this
diagnosis?
A. Regular rate and rhythm with an S3 gallop
B. Irregularly irregular rhythm with variable intensity of S1
C. Regular rhythm with a fixed split S2
D. Machinery murmur at the left infraclavicular area
, CORRECT ANSWER: B. Irregularly irregular rhythm with variable intensity of
S1
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm due to
chaotic atrial electrical activity. The intensity of S1 varies because of variable ventricular
filling times. An S3 gallop suggests heart failure, a fixed split S2 suggests atrial septal
defect, and a machinery murmur suggests patent ductus arteriosus.
Question 10: The point of maximal impulse (PMI) is normally located at:
A. The left fifth intercostal space at the midclavicular line
B. The left fourth intercostal space at the sternal border
C. The right second intercostal space at the sternal border
D. The left second intercostal space at the sternal border
CORRECT ANSWER: A. The left fifth intercostal space at the midclavicular line
Rationale: The PMI represents the apex of the left ventricle and is normally palpated at
the left fifth intercostal space at the midclavicular line in adults. Displacement of the PMI
may indicate cardiomegaly or mediastinal shift. The other locations correspond to
valvular auscultation areas, not the PMI.
Question 11: A nurse practitioner is performing an abdominal assessment.
Which of the following sequences represents the correct order of examination
techniques?
A. Palpation, percussion, inspection, auscultation
B. Inspection, auscultation, percussion, palpation
C. Auscultation, inspection, palpation, percussion
D. Inspection, palpation, percussion, auscultation
CORRECT ANSWER: B. Inspection, auscultation, percussion, palpation
Rationale: The correct sequence for abdominal assessment is inspection, auscultation,
percussion, and palpation. Auscultation is performed before percussion and palpation
because these maneuvers can alter bowel sounds. This sequence differs from other body
systems where palpation typically follows inspection.
Question 12: A patient presents with epigastric pain that radiates to the back
and is relieved by leaning forward. This presentation is most consistent with:
A. Peptic ulcer disease
B. Acute pancreatitis
C. Cholecystitis
D. Appendicitis
CORRECT ANSWER: B. Acute pancreatitis
Rationale: Acute pancreatitis classically presents with epigastric pain radiating to the
back that is relieved by leaning forward or assuming a fetal position. Peptic ulcer disease
Chamberlain University Graduate Nursing Study
Guide, Midterm & Final Exam Prep, Advanced
Health Assessment, Physical Examination, Clinical
Reasoning, Differential Diagnosis, SOAP Notes,
Health History, System-Based Assessment &
Practice Questions
Question 1: A 45-year-old patient presents with a 3-week history of persistent,
dry, nonproductive cough. Which of the following findings in the history of
present illness is most suggestive of an ACE inhibitor-induced cough?
A. The cough is accompanied by fever and night sweats.
B. The cough resolves when the patient lies down.
C. The patient began lisinopril therapy approximately 4 weeks ago.
D. The cough produces clear sputum in the morning.
CORRECT ANSWER: C. The patient began lisinopril therapy approximately 4
weeks ago.
Rationale: ACE inhibitor-induced cough typically develops within 1 to 2 weeks of
initiation but can be delayed up to several months. It is a dry, persistent cough that
resolves after discontinuation of the medication. Fever and night sweats suggest
infection, positional cough suggests GERD or postnasal drip, and sputum production
suggests infectious or inflammatory etiology.
Question 2: During auscultation of the lungs, a nurse practitioner hears a high-
pitched, musical sound predominantly on expiration that is diffuse throughout
both lung fields. This finding is most consistent with:
A. Pleural friction rub
B. Wheezing
C. Crackles
D. Stridor
CORRECT ANSWER: B. Wheezing
Rationale: Wheezing is a high-pitched, musical, continuous sound heard predominantly
during expiration. It results from narrowed airways due to bronchospasm, edema, or
secretions and is commonly associated with asthma or COPD. Pleural friction rub is a
grating sound heard on both inspiration and expiration, crackles are discontinuous
popping sounds, and stridor is a high-pitched inspiratory sound indicating upper airway
obstruction.
Question 3: Which of the following chest pain characteristics is most
consistent with pleuritic chest pain?
A. Pain that is relieved by leaning forward
B. Pain that worsens with deep inspiration
,C. Pain that radiates to the jaw and left arm
D. Pain that is burning and occurs after meals
CORRECT ANSWER: B. Pain that worsens with deep inspiration
Rationale: Pleuritic chest pain is sharp, well-localized, and worsens with deep
inspiration, coughing, or movement. It is caused by inflammation of the parietal pleura.
Pain relieved by leaning forward suggests pericarditis, pain radiating to jaw/arm
suggests cardiac ischemia, and burning postprandial pain suggests GERD.
Question 4: A patient with a history of heart failure presents with bilateral
crackles at the lung bases, jugular venous distension, and 3+ pitting edema of
the lower extremities. These findings are most consistent with:
A. Pulmonary embolism
B. Pneumonia
C. Acute decompensated heart failure
D. Chronic obstructive pulmonary disease
CORRECT ANSWER: C. Acute decompensated heart failure
Rationale: Bilateral basilar crackles, jugular venous distension, and peripheral edema are
classic signs of volume overload in heart failure. Pulmonary embolism typically presents
with unilateral findings and acute onset, pneumonia presents with focal crackles and
fever, and COPD presents with wheezing and barrel chest.
Question 5: When performing a cardiovascular assessment, the nurse
practitioner palpates a thrill at the left sternal border. This finding is most
consistent with:
A. Normal aortic valve closure
B. Turbulent blood flow from a valvular abnormality
C. Pericardial inflammation
D. Normal venous pulsation
CORRECT ANSWER: B. Turbulent blood flow from a valvular abnormality
Rationale: A thrill is a palpable vibration caused by turbulent blood flow, often
associated with valvular stenosis or regurgitation, or a ventricular septal defect. It is
never normal. Normal valve closure is felt as a tap, not a thrill. Pericardial inflammation
produces a friction rub on auscultation, not a thrill.
Question 6: A 55-year-old male presents with sudden onset of tearing chest
pain radiating to the back. He has a history of hypertension and is diaphoretic.
Which of the following findings on physical examination would most support a
diagnosis of aortic dissection?
A. Blood pressure differential of 20 mm Hg between arms
B. Holosystolic murmur at the apex
,C. Bilateral crackles at the lung bases
D. Pulsus paradoxus
CORRECT ANSWER: A. Blood pressure differential of 20 mm Hg between arms
Rationale: A blood pressure differential between arms of greater than 20 mm Hg is a
highly specific finding for aortic dissection, resulting from obstruction of a major branch
vessel. Holosystolic murmur suggests mitral regurgitation, crackles suggest heart failure,
and pulsus paradoxus suggests cardiac tamponade.
Question 7: The nurse practitioner is assessing a patient for orthostatic
hypotension. The correct technique involves:
A. Measuring blood pressure only in the supine position
B. Measuring blood pressure while the patient is seated only
C. Measuring blood pressure supine, then immediately upon standing, and after 3
minutes of standing
D. Measuring blood pressure in the supine position, then after 10 minutes of standing
CORRECT ANSWER: C. Measuring blood pressure supine, then immediately
upon standing, and after 3 minutes of standing
Rationale: Orthostatic hypotension is defined as a drop in systolic blood pressure of at
least 20 mm Hg or diastolic of at least 10 mm Hg within 3 minutes of standing. Proper
technique requires measurements in the supine position, immediately upon standing,
and after 3 minutes of standing to capture the full hemodynamic response.
Question 8: Which of the following is the most common cause of left
ventricular hypertrophy detected on physical examination?
A. Mitral valve prolapse
B. Chronic hypertension
C. Pericardial effusion
D. Aortic regurgitation
CORRECT ANSWER: B. Chronic hypertension
Rationale: Chronic hypertension is the most common cause of left ventricular
hypertrophy due to increased afterload against which the left ventricle must pump. This
leads to concentric hypertrophy. Mitral valve prolapse, pericardial effusion, and aortic
regurgitation do not typically cause LVH as their primary manifestation.
Question 9: A patient presents with a new onset of atrial fibrillation. Which of
the following findings on cardiac auscultation is most consistent with this
diagnosis?
A. Regular rate and rhythm with an S3 gallop
B. Irregularly irregular rhythm with variable intensity of S1
C. Regular rhythm with a fixed split S2
D. Machinery murmur at the left infraclavicular area
, CORRECT ANSWER: B. Irregularly irregular rhythm with variable intensity of
S1
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm due to
chaotic atrial electrical activity. The intensity of S1 varies because of variable ventricular
filling times. An S3 gallop suggests heart failure, a fixed split S2 suggests atrial septal
defect, and a machinery murmur suggests patent ductus arteriosus.
Question 10: The point of maximal impulse (PMI) is normally located at:
A. The left fifth intercostal space at the midclavicular line
B. The left fourth intercostal space at the sternal border
C. The right second intercostal space at the sternal border
D. The left second intercostal space at the sternal border
CORRECT ANSWER: A. The left fifth intercostal space at the midclavicular line
Rationale: The PMI represents the apex of the left ventricle and is normally palpated at
the left fifth intercostal space at the midclavicular line in adults. Displacement of the PMI
may indicate cardiomegaly or mediastinal shift. The other locations correspond to
valvular auscultation areas, not the PMI.
Question 11: A nurse practitioner is performing an abdominal assessment.
Which of the following sequences represents the correct order of examination
techniques?
A. Palpation, percussion, inspection, auscultation
B. Inspection, auscultation, percussion, palpation
C. Auscultation, inspection, palpation, percussion
D. Inspection, palpation, percussion, auscultation
CORRECT ANSWER: B. Inspection, auscultation, percussion, palpation
Rationale: The correct sequence for abdominal assessment is inspection, auscultation,
percussion, and palpation. Auscultation is performed before percussion and palpation
because these maneuvers can alter bowel sounds. This sequence differs from other body
systems where palpation typically follows inspection.
Question 12: A patient presents with epigastric pain that radiates to the back
and is relieved by leaning forward. This presentation is most consistent with:
A. Peptic ulcer disease
B. Acute pancreatitis
C. Cholecystitis
D. Appendicitis
CORRECT ANSWER: B. Acute pancreatitis
Rationale: Acute pancreatitis classically presents with epigastric pain radiating to the
back that is relieved by leaning forward or assuming a fetal position. Peptic ulcer disease
